Faculty go abroad to study epidemic

As some students labor to increase awareness of the HIV/AIDS epidemic with such events as AIDS Walk New Haven, and as scientists at the Yale School of Medicine study treatments for the disease, researchers at the Yale School of Public Health and Yale School of Nursing studying how to prevent the spread of HIV are taking a different approach. While some continue to do research in Yale’s backyard, many look abroad for research opportunities.

Of the 12 faculty members at the School of Public Health working on HIV prevention, nine either go overseas for their studies or collaborate extensively with foreign counterparts. These researchers’ work is focused primarily on four countries — Russia, China, India and South Africa — each of which offers a different perspective on the epidemic and therefore a unique research opportunity.

Though some researchers at the School of Public Health said more could always be done to support their work outside the United States, they said they have an ally in the Center for Interdisciplinary Research on AIDS.

CIRA Director Michael Merson, former dean of the School of Public Health, said it is easy to understand the need for research not confined to one country.

“The epidemic is global,” he said. “We can learn about how the disease is transmitted and treated. We can learn to do things better here.”

Why CIRA lists Russia, China, India and South Africa as its priorities for international research is more complex. The four countries comprise the bulk of CIRA and the School of Public Health’s focus, but for almost as many reasons as there are researchers.

Yale has a long-standing partnership with Russian researchers, said Nadia Abdala, associate research scientist at the School of Public Health. These collaborations have ranged from training visiting Russian researchers to conducting HIV prevention studies in Russia, often using some of the same scientists newly trained at Yale. Merson had connections to Russia dating back to his days in the World Health Organization and used them in 1997 and 1998 to bring Russia and Yale together on HIV/AIDS research, epidemiology and public health professor Kaveh Khoshnood said.

But tradition and past experience are not the only things attracting Yale researchers to Russia. The country has the world’s fastest growing HIV epidemic according to some sources, Khoshnood said, and the potential benefits to working there are still great.

“Russia is a place where the HIV epidemic is beginning,” Abdala said. “Anything done now can have a large impact in preventing the spread of this disease.”

Though HIV/AIDS is a single disease, it spreads in distinct ways in different regions, attracting researchers interested in specific modes of transmission, said Tamra Madenwald, assistant director at the Office of International Training at CIRA. She said Robert Heimer, a professor of epidemiology and public health who studies HIV transmission in Russia, did pioneering work in showing the effectiveness of needle-exchange programs, research that took place in New Haven. He now does work in Russia, where injection drug use is driving the epidemic, she said.

In India, meanwhile, Kim Blankenship, associate director at CIRA, applies her background in her early sociological studies with sex workers in New Haven to work on structural interventions in India, where the disease spreads most rapidly through commercial sex workers.

India and Russia are the two largest venues for CIRA’s international AIDS research, Khoshnood said. Both countries have large populations and growing epidemics, and both have recently seen increased interest throughout the University. Yale President Richard Levin has made numerous trips to the two countries, including one in 2005 in which he opened a satellite office for CIRA in Chennai, India.

“It’s one of our most visible programs in India,” Levin said. “Our visit there last year did generate a lot of interest.”

Yale’s relationships with China are not a recent development, with the Yale-China Association dating back to 1901, but Khoshnood said it has only been in the last 10 years that CIRA began to consider health in China as an area for change. The Yale School of Nursing has programs in China to help train health-care providers to cope with the specific challenges HIV poses in preventing disease transmission, led by Ann Williams, a professor of nursing and trustee of the association.

CIRA is unique among Yale research centers, CIRA Research Coordinator Kevin Irwin said. Unlike most, it does not seek out grants for individual projects, nor does it have a permanent staff devoted solely to research. Rather, Irwin said, CIRA focuses on supporting AIDS research being done by Yale faculty members across all disciplines.

Khoshnood, who at Yale first studied public health problems in New Haven, said CIRA was the impetus for much of the recent increase in overseas AIDS research.

“Really it was CIRA that provided a platform for people interested in international work,” he said.

As research in New Haven and beyond continues to grow, research priorities may change, epidemiology and public health professor Trace Kershaw said.

“It’s going to be more and more focus on heterosexual risk and looking at both males and females,” he said. “Traditionally we’ve focused on one or the other. There will be more emphasis on diet, family and community effects.”